Editor's Choice - Infective Native Aortic Aneurysms: A Delphi Consensus Document on Terminology, Definition, Classification, Diagnosis, and Reporting Standards

Karl Sörelius; Thomas R Wyss; Academic Research Consortium of Infective Native Aortic Aneurysm (ARC of INAA); Donald Adam; Adam W Beck; Xavier Berard; Jacob Budtz-Lilly; Nabil Chakfé; Rachel Clough; Martin Czerny; Mario D'Oria; Michael Dang; Pietro G di Summa; Nikolaj Eldrup; Inge Fourneau; Ivika Heinola; Akihiro Hosaka; Ron-Bin Hsu; Yao-Kuang Huang; Warissara Jutidamrongphan; Chung-Dann Kan; Tilo Kölbel; Christopher Lau; Martin Lawaetz; Kevin Mani; Konstantinos Moulakakis; Gustavo S Oderich; Timothy Resch; Jürg Schmidli; Petr Sedivy; Takuro Shirasu; Ruedeekorn Suwannanon; Zoltan Szeberin; Joseph Touma; Jos C van den Berg; Hugo Veger; Anders Wanhainen; Salome Weiss

doi:10.1016/j.ejvs.2022.11.024

Editor's Choice - Infective Native Aortic Aneurysms: A Delphi Consensus Document on Terminology, Definition, Classification, Diagnosis, and Reporting Standards

Eur J Vasc Endovasc Surg. 2023 Mar;65(3):323-329. doi: 10.1016/j.ejvs.2022.11.024. Epub 2022 Dec 5.

Authors

Karl Sörelius¹, Thomas R Wyss²; Academic Research Consortium of Infective Native Aortic Aneurysm (ARC of INAA); Donald Adam³, Adam W Beck⁴, Xavier Berard⁵, Jacob Budtz-Lilly⁶, Nabil Chakfé⁷, Rachel Clough⁸, Martin Czerny⁹, Mario D'Oria¹⁰, Michael Dang¹¹, Pietro G di Summa¹², Nikolaj Eldrup¹³, Inge Fourneau¹⁴, Ivika Heinola¹⁵, Akihiro Hosaka¹⁶, Ron-Bin Hsu¹⁷, Yao-Kuang Huang¹⁸, Warissara Jutidamrongphan¹⁹, Chung-Dann Kan²⁰, Tilo Kölbel²¹, Christopher Lau²², Martin Lawaetz¹³, Kevin Mani²³, Konstantinos Moulakakis²⁴, Gustavo S Oderich²⁵, Timothy Resch¹³, Jürg Schmidli²⁶, Petr Sedivy²⁷, Takuro Shirasu²⁸, Ruedeekorn Suwannanon²⁹, Zoltan Szeberin³⁰, Joseph Touma³¹, Jos C van den Berg³², Hugo Veger¹¹, Anders Wanhainen²³, Salome Weiss²⁶

Affiliations

¹ Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Electronic address: karlsorelius@hotmail.com.
² Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Kantonsspital Winterthur, Department of Interventional Radiology and Vascular Surgery, Winterthur, Switzerland.
³ University Hospitals Birmingham, Birmingham, UK.
⁴ University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL, United States.
⁵ Vascular and General Surgery Department, Bordeaux University Hospital, Bordeaux, France.
⁶ Division of Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France, and GEPROMED Strasbourg, France.
⁸ School of Biomedical Engineering and Imaging Science, King's College London, London UK, and Department of Vascular Surgery, Imperial Healthcare NHS Foundation Trust, London, UK.
⁹ Department of Cardiovascular Surgery, University Heart Centre Freiburg University, Freiburg, Germany.
¹⁰ Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Italy.
¹¹ Haga Teaching Hospital, The Hague, The Netherlands.
¹² Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
¹³ Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁴ Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
¹⁵ Helsinki University and Helsinki University Hospital, Helsinki, Finland.
¹⁶ Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
¹⁷ National Taiwan University Hospital, Taiwan.
¹⁸ Chiayi Chang Gung Memorial Hospital, Taiwan.
¹⁹ Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
²⁰ College of Medicine, National Cheng-Kung University and National Cheng-Kung University Hospital, Taiwan.
²¹ German Aortic Center, Department of Vascular Medicine, University Hospital Eppendorf, Hamburg, Germany.
²² Weill Cornell Medicine, New York, NY, USA.
²³ Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
²⁴ University Hospital of Patras, University of Patras, Patras, Greece.
²⁵ Division of Vascular and Endovascular Surgery, Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
²⁶ Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
²⁷ Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic.
²⁸ Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan.
²⁹ Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand.
³⁰ Department of Vascular Surgery, Semmelweis University, Budapest, Hungary.
³¹ Vascular Surgery Department, Henri Mondor University Hospital, Creteil, France.
³² Centro Vascolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland; Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 36470311
DOI: 10.1016/j.ejvs.2022.11.024

Abstract

Objective: There is no consensus regarding the terminology, definition, classification, diagnostic criteria, and algorithm, or reporting standards for the disease of infective native aortic aneurysm (INAA), previously known as mycotic aneurysm. The aim of this study was to establish this by performing a consensus study.

Methods: The Delphi methodology was used. Thirty-seven international experts were invited via mail to participate. Four two week Delphi rounds were performed, using an online questionnaire, initially with 22 statements and nine reporting items. The panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements revised, and results presented in iterative rounds. Consensus was defined as ≥ 75% of the panel selecting "strongly agree" or "agree" on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha coefficient > .80.

Results: All 38 panellists completed all four rounds, resulting in 100% participation and agreement that this study was necessary, and the term INAA was agreed to be optimal. Three more statements were added based on the results and comments of the panel, resulting in a final 25 statements and nine reporting items. All 25 statements reached an agreement of ≥ 87%, and all nine reporting items reached an agreement of 100%. The Cronbach's alpha increased for each consecutive round (round 1 = .84, round 2 = .87, round 3 = .90, and round 4 = .92). Thus, consensus was reached for all statements and reporting items.

Conclusion: This Delphi study established the first consensus document on INAA regarding terminology, definition, classification, diagnostic criteria, and algorithm, as well as reporting standards. The results of this study create essential conditions for scientific research on this disease. The presented consensus will need future amendments in accordance with newly acquired knowledge.

Keywords: Classification; Criteria; Definition; Diagnosis; Infective native aortic aneurysm; Mycotic aneurysm.